Health Care Access and Affordability Among US Adults Aged 18 to 64 Years With Self-reported Post–COVID-19 Condition

Abstract

ImportanceMany US adults report having post–COVID-19 condition (PCC), but little is known about their access to health care.ObjectiveTo estimate the association of PCC with access and affordability challenges among US adults aged 18 to 64 years.Design, Setting, and ParticipantsThis survey study used data from the Health Reform Monitoring Survey, a probability-based internet survey conducted June 17 to July 5, 2022. Participants included a nationally representative sample of 9484 US adults ages 18 to 64 years drawn from the Ipsos KnowledgePanel.Main Outcomes and MeasuresSelf-reported PCC was defined as experiencing symptoms more than 4 weeks after first having COVID-19 that were not explained by another condition or factor. Access and affordability outcomes included having a usual place of care; forgoing care in the past 12 months because of costs, difficulty finding clinicians, or difficulty using health insurance; having problems paying family medical bills in the past 12 months; and having past-due medical debt.ResultsOf 19 162 panel members recruited for the survey, 9599 individuals completed the survey (completion rate, 50.1%) and 9484 respondents were included in the final analytic sample (4720 females [50.6%, weighted]; mean [SD] age, 41.0 [13.5] years). A total of 3382 respondents (36.4%; 95% CI, 34.7%-38.2%) reported ever being diagnosed with COVID-19, among whom, 833 respondents (22.5%; 95% CI, 20.9%-24.2%) reported currently having PCC. After adjustment for differences in demographic, health, and geographic characteristics, adults with PCC were more likely than 2549 adults with a COVID-19 diagnosis but no report of PCC and 6102 adults never diagnosed with COVID-19 to report unmet health care needs in the past 12 months because of the following challenges: costs (27.0%; 95% CI, 23.2%-30.7% vs 18.3%; 95% CI, 15.9%-20.7% and 17.5%; 95% CI, 15.4%-19.6%) and difficulties finding clinicians accepting new patients (16.4%; 95% CI, 14.3%-18.4% vs 10.1%; 95% CI, 8.8%-11.5% and 10.7%; 95% CI, 9.6%-11.8%), getting a timely appointment (22.0%; 95% CI, 19.3%-24.8% vs 14.4%; 95% CI, 13.2%-15.7% and 13.9%; 95% CI, 12.9%-14.8%), and getting health plan care authorization (16.6%; 95% CI, 14.6%-18.6% vs 10.8%; 95% CI, 9.6%-12.1% and 10.3%; 95% CI, 9.4%-11.2%) (P < .001 for all comparisons).Conclusions and RelevanceThis study found that adults aged 18 to 64 years with PCC were more likely than other adults to have difficulty getting and paying for health care. These findings suggest that policies aimed at improving access and affordability may focus on accelerating development of treatments and clinical guidelines, training clinicians, and addressing insurance-related administrative and cost barriers.